A thing came up in today's Background Noise that got me wondering. It's a fairly gruesome subject to think about, yet some thought is probably necessary for the sake of things yet to come, and possibly for our own collective peace of mind as well.

Here's a summary of the episode in question. For background, a very old woman has just died (or is in the process of dying) of an apparent heart attack on a dance floor in Kiyoka, surrounded by player characters, and a mob of dancing NPCs who can be ignored in all this -- with the single, important exception of her similarly aged, loving, and obviously horrified, husband. One of them is doing her very best to make an incredibly dreadful experience slightly less dreadful, at least for the husband if not for the dying woman...

Desiree wrote:"Keep trying," I say to Therese. While she attends the heart, I bend over the woman and press my lips against hers. I breathe into her, calling on Anilis to aid me. I fill her lungs with air and magic. While I keep breathing into her, I draw one hand around and move it up her back, up her neck, and over her head. The magic in her blood follows my hand. I pull her blood, which her heart can no longer pump, up into her head.

Her eyes open and she gasps. I pull back to give her some space, but I keep my hands on her head to keep her blood flowing.

"You're heart's stopped," I tell her. "I not from around here, so I don't know if there's anything that can be done about that. If there's not... you have time to say goodbye to your husband." And if there is, I hope someone who knows what they're doing gets their ass over here soon. This bypass spell isn't going to last long.

I find this action, while incredibly noble on Desiree's part, to be ... troubling.

Here's what's bugging me. I know very little about brain death, having not been there with any of my departed loved ones as they passed through it. (I'm not sure whether to add "I'm happy to say," on the grounds of having been spared such an experience, or "I'm sad to say," on the grounds that it might -- might -- have been comforting to them if I'd been there when it happened; therefore I will add neither.) However, it is my understanding, based only on things I've read in less-than-authoritative sources, that what Desiree is doing here is not a merciful thing, however well-intentioned it obviously is. My reasoning, such as it is, is that in a situation like this, the near-instant cessation of heart activity will have caused a similarly instantaneous drop in blood pressure in the brain, so that the poor woman simply loses consciousness within seconds at most. Prolonging that consciousness, even for the noble purpose of giving the dying woman a chance at a last goodbye, will mean awareness of her body shutting down around her mind ... which would be unpleasant. As Drusia, playing Desiree, puts it:

Drusia wrote:OOC2: Oh, and the woman is probably in a fair amount of pain - muscle death is quiet painful. Unless Therese's attentios are soothing that pain somewhat.

Last things first: if the pain is there, I'm pretty sure that all three women ministering to the victim would be doing what they could, along with their unsuccessful attempts at resuscitation, to mitigate it; they're all compassionate, caring human beings as well as Healers, no need to worry about that. But what I wonder is whether there would be any pain ... if steps hadn't been taken to keep that fading mind alive. Drusia, I'm not sure what you mean by "muscle death," and honestly, I'm not sure I want to know... but it sounds bad.

So how badly mistaken am I in this? Again, sorry to raise a seriously gruesome subject, but some answers will help guide the next round of interactions in that thread -- as well as giving us things to think about that we'd probably rather not.

Hey! Udo's this close to a night of passion with a kobold! And I think Drusia's in the middle of one (though that one has proven resistant in the past).

My own view is that this is way more technical a worry than we need for a fantasy game. You (in this post) and Drusia (in play) already pointed out there's enough magic around that people could reasonably be keeping this woman out of pain while trying to keep her alive long enough to say goodbye to her husband, so that there's no cruelty in the act at all. (Desiree may well cause a lot of pain she isn't planning to, but it's never been to the physical heart - in the scene where she met Tim it was established that she's very good with the magical equivalent of heart surgery; and as that scene showed, healing is the one area where she's always shown only unmitigated kindness, even to rude crusty old Veracian bishop-types.)

Think of the old woman as being like the dying captain in The Good, the Bad, and the Ugly -- where he grabs the doctor's shirt and croaks out - "Keep me alive a little longer - expect good news!" - he knows Blondie's planning to blow up Braxton Bridge, and when he survives long enough to hear it, he dies with a smile on his face. The only "hospice care" he has is the hootch he's been drinking, but if the doctor' s actually helped him stay conscious, no one can doubt it's a kindness he wanted even though there is extra pain involved. And here there is no need even for that to be so, and I think most married folks would be glad of a few extra seconds, even if there was some agony involved, for a chance to say "bye, love" and give the other half a smile. And leaving it like that makes for a better story.

The three women who have gathered around the dying one are obviously all compassionate, caring people, almost to a fault. Two of the three, Desiree and Therese, also have plenty of experience with death, and the younger Marilyn, while lacking direct experience, knows that helping people through it is part of her job, whether she's had to do it or not. It follows that each of them would be trying as hard as possible to do the right thing here -- yet their views of what that "right thing" is seem to be more divergent than would be fully in character. It would be nice to avoid pitfalls in the role playing that might result from the players knowing less about the topic than the characters would. I mean, maybe Therese has to think about that kind of thing day-to-day by dint of the mission she has, but I certainly don't!

Which brings me to the second, rather morbid point. You and I are a bit older than most role players, and I, at least, am not too many years away from having to make (or at least help make) some painful decisions regarding loved ones who are starting on that fateful last journey. Presumably, when that does happen, my wife and I, and our respective sibs who will be shouldering the load as well, will be getting some good professional help with the decision making. For now, it's all far enough in the future that we neither have nor need that help -- yet this episode has struck a nerve with me personally that is amplified by the fact that the exact scenario in this episode happened to a good friend of mine, and something related happened to my own family. Again, I'd like to get it right, for my own peace of mind if nothing else.

We now return you to Udo's attempt to "die" in the Shakespearean sense , but there's a little more to this, at least for me, than just a matter of getting unnecessarily technical in the game.

I think the magic here sorts out the medical issues - leaving just the moral one: is the old woman better not knowing that she's dying, or getting a moment to say something comforting to her husband?

Given her age, and that she's been presented (if I understand it) as one of "Marilyn's people" - i.e., a convert who believes in the Life Eternal - I should think she's had plenty of time to reconcile herself to her impending death and to face it calmly. And to want to soften the blow to her husband by showing him she was facing it calmly.

Graybeard wrote: Drusia, I'm not sure what you mean by "muscle death," and honestly, I'm not sure I want to know... but it sounds bad.

So how badly mistaken am I in this? Again, sorry to raise a seriously gruesome subject, but some answers will help guide the next round of interactions in that thread -- as well as giving us things to think about that we'd probably rather not.

Muscle death is when a muscle in the human body dies. Upon death, it releases a chemical that, for various medical reasons, is quite painful. This is one of the reasons why heart attacks hurt.* Edit 3, Note: The muscle death I mean is the death of her heart. The other muscles would remain alive for some time after the brain dies. Heart attacks are (typically) caused by a bloodclot starving a piece of the heart until it dies of lack of oxygen, which makes that part unable to pump, which slows or stops bloodflow throughout the body, which in turn starves the brain. The pain of a heart attack is caused by the muscle tissue there dying and releasing the chemicals associated with muscle death.

On the other hand, Desiree wasn't just proving blood to the brain, she was proving blood to the whole body - like a heart bypass, where they run the blood through a machine pump, except that she didn't have a pump so she "pulled" the blood instead. It would have the same basic effect as keeping someone on a bypass machine until it came time to "pull the plug".

This is something actual doctors do rather often - to let the patient say goodbye to family and make last arrangements. If it can be achieved in time.

Edit: Oh. And a patient can last for days on a bypass machine. Desiree doesn't have enough juice to maintain such a thing herself more than a few minutes.Also, I was unclear on one thing - did the woman actually say goodbye to her husband? Or is that what this discussion thread is designed to determine?

Edit 2: One last thing - if a transplant is possible, then bypass is how doctors keep the patient alive while they're removing one heart and putting the new one in. Hence my question about golem hearts (ie, a magical version of an artificial heart).

Edit 4: My mother is in the medical industry, and I was a pre-med student before I switched to an English major. Hence the massive pile of medical facts, info, and terms above.

Last edited by Drusia on November 16th, 2012, 12:28 pm, edited 1 time in total.

Drusia wrote:Also, I was unclear on one thing - did the woman actually say goodbye to her husband? Or is that what this discussion thread is designed to determine?

Yes, this was the question that I had in mind. My followup in the actual thread was intended to leave that open. The woman is gone now, but whether she had a chance to say goodbye hasn't yet been resolved.

As I mentioned, almost this exact thing happened to a friend of mine some years ago (it was the husband that succumbed in that case rather than the wife), with him in a role not unlike Therese's here. In that particular incident, the old line "dead before he hit the floor" was close to the truth; what happened to the poor man was "sudden cardiac death" rather than a heart attack (myocardial infarction). There happened to be a fairly large number of EMTs and medical professionals in the bar at the time, my friend among them, and they went to work on the guy almost instantly. It didn't matter, he was unresponsive from the moment it happened, and would have had no chance whatever to say goodbye to his wife. Of course, they were disadvantaged in that situation, relative to the Poe-verse, by not having magic to help them out.

Enough of this morbid subject. Let's roll with the event in the Leaping Lizard, however people want to play it; again, she's gone (people do die in Tsuiraku), but what happens en route to that unhappy outcome is still up to our collective druthers.